Prompt Payment Laws by State & Sample Appeal Letter

Transcription

1 Prompt Payment Laws by State & Sample Appeal Letter State Payment Timeframe Penalty(ies) Contact Alabama 30 working for electronic claims; 45 paper DOI fine Alabama Department of Insurance, Life and Health Division Alaska Paper: 20 working Electronic: 10 working < $250: 5 % payment or $5, whichever is less > $250: 2 % of the payment Alaska Division of Insurance (907) Arizona All claims types: 30 after claim approved Legal interest rate Arizona Department Of Insurance (602) Arkansas Paper: 45 calendar Electronic: 30 calendar 12% annually Arkansas Insurance Department (501) or California Non-HMOs: 30 working HMO's: 45 working 15% annually; $10 additional non-inclusion of interest with payment California Department of Insurance (800) 927-HELP (4357) (213) Colorado All claim types: 45 working 10% annually; > 90 3% claim amount Colorado Division of Insurance (800) Toll Free Connecticut All claim types: 45 working 15% annually State of Connecticut Insurance Department (860) Delaware All claim types: 30 working Maximum allowable lending rate Delaware Insurance Department (302) District of Columbia All claims types: 30 working after receipt of claim 1.5%: %: % thereafter Department of Insurance and Securities Regulation (202) Florida HMO claims: 35 Non-HMO claims: 45 Claim requesting additional information: % annually Florida Department of Financial Services (850) Georgia All claim types: 15 working 18% annually Georgia Insurance Fire and Safety Commission elizabeth@elizabethwoodcock.com Do not redistribute without permission - 1 -

2 Hawaii Paper: 30 Electronic: 15 15% annually; fines assessed Hawaii Department of Commerce and Consumer Affairs Idaho All claim types: 30 working Legal rate of interest Idaho Department of Insurance Illinois All claim types: 30 9% annually Illinois Department of Insurance Indiana Paper: 45 Electronic: 30 2% annually (changes each year; check website) Indiana Department of Insurance (317) Iowa The rules shall be same as time for group health plans established by the U SDOL pursuant to 29 C.F.R. pt % annually Iowa Insurance Division Toll Free: Kansas All claim types: 30 1% annually Topeka Office Phone: Wichita Office Phone: Kentucky All claim types: 30 to pay or deny 12% annually if % annually if % over 91 Kentucky Department of Insurance (800) Louisiana Paper: submitted w/in 45, 45 to pay Electronic: 25 1% of unpaid balance; additional 1% penalty added for each 25 remains unpaid Louisiana Department of Insurance (225) Maine All claim types: % per month Maine Bureau of Insurance, Tel: (in state) or Maryland All claim types: % per month % per month % per month over 121 Maryland Insurance Administration Massachusetts Michigan All claim types: 45 after receipt Non-contracted providers: % per month Massachusetts Division of Insurance (617) % annually Office of Financial and Insurance Services elizabeth@elizabethwoodcock.com Do not redistribute without permission - 2 -

3 Minnesota All claim types: % per month Minnesota Department of Commerce y=commerce Mississippi Missouri Paper: 35 Electronic: 25 All claim types: % per month Mississippi Department of Insurance (601) or % per month Missouri Department of Insurance (573) Montana All claim types: 30 18% annually Montana Department of Insurance (402) / TDD (800) Nebraska All claim types: 45 Submit prompt pay report to DOI for consideration Nevada All claim types: 30 nv.us/g- TaskForceTimely PayOfClaims- 2.pdf Nebraska Department of Insurance (402) Carson City Office : (775) Las Vegas Office: (702) New Hampshire New Jersey New Mexico Paper: 45 Electronic: 15 Paper: 40 Electronic: 30 Paper: 45 Electronic: % monthly State of New Hampshire Insurance Department % annually New Jersey Department of Banking and Insurance % monthly New Mexico Public Regulation Commission-Insurance Division (505) New York All claim types: 45 Interest is calculated as the greater of 12% per annum or the rate set by the commissioner State of New York Insurance Department North Carolina All claims types: 30 18% annually North Carolina Department of Insurance North Dakota All claim types: 15 None given North Dakota Department of Insurance (701) phone Ohio All claim types: 30 18% annually The Ohio Department of Insurance (614) Oklahoma All claim types: 45 10% annually > 6 interest rate same as US rate Oklahoma Insurance Department (405) or (800) elizabeth@elizabethwoodcock.com Do not redistribute without permission - 3 -

4 Oregon All claims types: 30 12% annually Oregon Department of Consumer and Business Services Phone: Pennsylvania All claim types: 45 10% annually Pennsylvania Insurance Department Philadelphia, PA Phone: (215) Rhode Island All claims: 30 12% annually Department of Business Regulation Telephone No. (401) South Carolina Paper: 45 Electronic: 30 6% annually South Carolina Department of Insurance (803) South Dakota Paper: 45 Electronic: 30 None indicated South Dakota Division of Insurance Tennessee Paper: 30 Electronic: 21 1% monthly Tennessee Department of Commerce and Insurance Texas HMO's only: 45 18% annually Texas Department of Insurance (512) Utah All claim types: 30 May be applied according to formula Utah Insurance Department (800) Vermont All claim types: 45 12% annually State of Vermont Insurance Division m Virginia All claim types: 45 Daily legal rate of interest Virginia State Corporation Commission Washington West Virginia 90% monthly volume:30 90% monthly volume: payment or denial 60 Paper: 40 Electronic: 30 1% monthly Washington State Office of the Insurance Commissioner % annually West Virginia Insurance Commission t.htm Wisconsin All claim types: 30 12% annually Office of the Commissioner of Insurance (608) Wyoming All claim types: 45 10% annually Wyoming Insurance Department elizabeth@elizabethwoodcock.com Do not redistribute without permission - 4 -

5 Sample Appeal Letter: State Prompt Payment / Open Claim NOTE: Sample provided for Georgia; refer to information regarding your state s prompt payment law. Date To Whom It May Concern: Thank you for the opportunity to submit this denied claim for reconsideration of payment. We are contacting you about the services rendered to [Details about the patient s name, date of service, and services rendered]. We request immediate payment of the above referenced claim. According to our records, this claim was filed on [date of filing], however, payment has not yet been received. We believe that failure to release payment may be a violation of Georgia Code 33. According to Georgia Code (b)(1): All benefits under a health benefit plan will be payable by the insurer which is obligated to finance or deliver health care services under that plan upon such insurer s receipt of written proof of loss or claim for payment for health care goods or services provided. The insurer shall within 15 working after such receipt mail to the insured or other person claiming payments under the plan payment for such benefits or a letter or notice which states the reasons the insurer may have for failing to pay the claim, either in whole or in part, and which also gives the person so notified a written itemization of any documents or other information needed to process the claim or any portions thereof which are not being paid. Where the insurer disputes a portion of the claim, any undisputed portion of the claim shall be paid by the insurer in accordance with this chapter. When all of the listed documents or other information needed to process the claim have been received by the insurer, the insurer shall then have 15 working within which to process and either mail payment for the claim or a letter or notice denying it, in whole or in part, giving the insured or other person claiming payments under the plan the insurer s reasons for such denial. Note: full text at: Based on this state mandate and the fact that this is a "clean claim", we ask that this claim be adjudicated immediately. Thank you for your reconsideration. Sincerely, [Your Name] Account Representative Author s note: The sample appeal letter does not guarantee payment, and is offered as a sample only. elizabeth@elizabethwoodcock.com Do not redistribute without permission - 5 -